A disturbing
article
appeared in the South China Morning Post this week written by Chinese journalist, Lijia Zhang. A visit to the hospice in China where her father was recently moved left her shocked at the conditions for those who did not have family to sit with and look after them, and worried about the dignity of the elderly in China in general - even more so given the increase in the elderly population to come. She writes:

At 50 and in excellent health, I had hardly given any thought to ageing. Having spent the past two weeks at my father's hospice in Nanjing, however, I was pushed to confront the grim reality of it and the extremely alarming situation China's vast ageing population will face… Caregivers are supposed to provide a 24-hour service, from changing nappies to feeding people and cleaning rooms. Weighed down with too many tasks, however, they cannot respond to each patient's every need instantly.

China is aging at an unprecedented speed, with long waiting lists to get into hospices or retirement care due to increases in average life span. On top of that, the one child policy and a drop in fertility rates have resulted in fewer young people to look after them, and many single children with all the burden of looking after elderly parents falling only on them. Zhang further observes:

Traditionally, Chinese parents relied on their children for old-age care. My beloved grandmother, a courtesan turned concubine, suffered war, famine and other hardships in life. By the time she neared the end of her life, however, she regarded herself as a very fortunate woman as she was well cared for by her daughter's family. For someone of her generation, having "three generations of the family under one roof" was the ultimate happiness. Today, rapid development, urbanisation, smaller families, a more mobile population and an ever more individualistic society have loosened family ties and broken the traditional elderly care system.

It is sad that China seems to be following the West in a more individualistic culture. I admire cultures where families pull together to cover each others' various needs at different stages of life in a reciprocal way. In the West we tend to value independence more. Currently, China's care facilities can accommodate only around 1.6 per cent of its old people. Yet, according to research released last year by Peking University's
China Health and Retirement Longitudinal Study
, only 38 per cent of elderly people live with their children. Those who live away from their parents in China's increasingly urban society usually only have the time and money to visit home once a year at Chinese New Year. Where will these people go if current facilities are already over-worked? Zhang writes of an uncertain future for the soon-to-be elderly:

At one point, when my sister and her grown son were visiting, my sister half-joked: "Son, one day, you'll have to treat me the same way I am treating my father." Her son scratched his head and smiled politely.

The truth is that he may not be able to, even if he is willing. He and his wife, also a single child, will have to look after her parents as well. By 2053, some 35 per cent of the total population will enter the so-called "grey tide", compared with the world average of 20 per cent.

This issue will have to be jointly dealt with by the government, society, family and individuals. In fact, an all-out war is needed. The government should build more affordable old people's homes; communities should build leisure centres and other facilities for the elderly and train community nurses to provide basic medical care.

Volunteers should be encouraged to visit the elderly. One of my father's neighbours, a bed-bound old woman, told me that she hates the loneliness more than the physical suffering.

In Nanjing, the local government is considering a new policy: to pay a family member to care for the old person at home, provided some criteria are met. Different levels of the government will all have to come up with more, similarly creative, ideas.

Creative ideas and an awareness on the part of all the community sound like they are, and will certainly be needed, in China. Here in New Zealand a demography professor at Harvard University's School of Public Health
visited
last week, also warning this country that preparation, policy changes, and action are all key to managing imminent increases in the elderly population.